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  • Dr Paul Dhillon MBBCH CCFP

Don't let Depression get you down


An exam patient presents with classic symptoms of dysthymia. Her symptoms take up most of the day, on most days, for at least 2 years (just like Family Medicine residency). I state DYSTHYMIA as the diagnosis.

I’d be marked wrong.

Why? Dysthymia has been removed with the latest iteration of the DSM V! We are in a transition now where you may have learned DSM IV diagnoses in medical school and your clinical rotations, but you need to be up to date on the most recent clinical standards.

Psychiatry forms a large part of the examination and will be a large part of your practice so make sure you dedicate enough time to the subject matter. Here are some key tips that you need to keep on the tip of your pen and top of your mind to keep your mental health in tip-top shape for the exam.

The 3 S’s

  • Suicide – Always Ask And Admit (if you are worried at all!). Ask around your program to hear about the person who walked out of a SOO and forgot this key piece of the puzzle!

  • SADPERSONS – Risk Factors for Suicide include Sex (male), Age (>60 or <18), Depression, Previous attempts, Ethanol abuse, Rational thinking loss, Suicide in family/friends, Organized plan, and Serious Illness (*Think of Cancer and Chronic Pain). While you may not need to calculate a SADPERSONS score, you may need to state that your management is "send to hospital and consult psychiatry" rather than "follow up in 6 months."

  • SIGECAPS – Simple. Know it. Start with asking about Mood and then Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor changes, and Suicidal thoughts. You need to find 5 of the symptoms with one being Low Mood/Interest (MI) lasting 2 weeks to diagnose with Major Depressive Disorder. Not only could this be fodder for SAMPS but a great way to get those extra points in the SOOs.

The faculty of The Review Course is working hard all year to prepare ourselves and the course content to make your weekend of review in Vancouver or Toronto invigorating, educational, and valuable to your exam preparation and your practice. We want you to succeed on your exams with an added resource that we did not have when we were studying: The Review Course.

We’ll be sharing our own tips and tricks to maximize your study time for the CCFP exam over the course of the year through our FREE emails but if you want all the tips and training we can provide you’ll need to join us at the course in 2016. Registration is now open with early bird discounts expiring in just a few days - register now!


One of the hardest thing in Residency for me was thinking about how to manage a depressed patient in residency. I often fell into the trap of trying to ‘fix’ the problem in one visit with an incredible management plan, an assumption that the outside world would cooperate, and an assumption of 100% compliance with medication. When I hit the real world I realized that I couldn’t cure conditions in 15 minutes or less, especially when dealing with complex comorbidities and psychiatric illnesses.

What’s important to remember is that time and a follow-up visit is an important part of your management of the patient. A close follow up vs. a longer follow up is a different management tool in your management toolbox. Don’t forget this in practice and don’t forget that you could earn points on an exam by not only saying “Arrange follow up” but making sure you arrange follow-up in an APPROPRIATE INTERVAL. So, be as detailed as possible and instead, say “Arrange follow up IN ONE WEEK.”

Outside of your medical care don’t forget about the Social Determinants of Health. As a physician you are a link for your patients to resources in the local community. Referral to social work, a food bank, or community support groups for other patients with depression can and should be a part of your bio-psycho-social management plan. Some provinces provide funding for special diets for patients with medical conditions (even HTN, Hyperlipidemia, or Diabetes!) – suggesting this to your patient and filling out the form if they qualify can mean a small but significant financial bonus.

Remember a key mantra of The Review Course: Management = More than Medication!

That’s it for now. Participants in The Review Course will receive our exclusive “Twas the Night Before the Exam” cram sheet full of simple but essential information to make your exam experience a breeze.

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